Prevention of depression: Immediate need but distant horizon

Depression is a leading cause of disability-adjusted life years lost and projected to be more so within a generation. Mood disorders were implicated in 10% of all hospitalizations in 2004. Despite major advances in depression-care management, there is little expectation that health policy will generate the necessary number of mental health providers to meet the need. Moreover, only 50% of patients with major depressive disorder (MDD) fully respond to initial antidepressant treatment. At best, an additional 33% will recover when the antidepressant is switched to another agent or augmented with a second antidepressant or psychotherapy. For those who do recover, 40% to 60% will experience recurrence depending on the severity of the initial episode. As a result, the need to prevent depression is imminent and numerous studies suggest that the means may be at hand.